Chest pain virtual ward (CPVW): a prospective analysis of a novel care model for low-risk acute coronary syndrome

Background Acute Coronary Syndrome (ACS) accounts for nearly 20% of acute hospital admissions (1). While validated risk tools (GRACE and HEART scores) can effectively stratify low-risk patients (2), acute inpatient management remains resource-intensive. Our retrospective feasibility study (3) showed a favourable safety outcome and potential financial benefits, including reduced acute-bed days, from streaming these patients into the chest pain virtual ward (CPVW). Purpose In this prospective analysis, we envisaged CPVW as an alternative model of care for low-risk patients with ACS, whilst offering safe remote monitoring and timely elective interventions, enabling early discharge and improving patient flow. Methods This study compared a prospective cohort of low-risk ACS patients managed via a dedicated CPVW (March 2025–February 2026, n=30) with a retrospective inpatient cohort identified from the Myocardial Ischaemia National Audit Project (MINAP) registry (March 2022–April 2023, n=55). Low-risk ACS was defined by a GRACE score <140, HEART score <4, non-dynamic ECGs, down-trending troponins, and absence of ongoing chest pain. The primary endpoints were 30-day readmission and all-cause mortality, along with evaluation of total inpatient length of stay (LOS) and time to elective coronary angiography. Results Baseline demographics and cardiovascular risk factors were comparable between groups (Figure 1). Median in-hospital stay was significantly shorter in the CPVW cohort (2 [IQR 1–4] vs 4 [IQR 2–7] days; p=0.003), demonstrating a mean reduction of 2.00 days (95% CI 0.73–3.27; p=0.0026). While the CPVW cohort experienced a longer overall wait to angiography (9 [IQR 7–14] vs 3 [IQR 0–4] days; p<0.001; mean difference 7.67 days, 95% CI 5.59–9.74), this was safely managed in the outpatient virtual setting. Consequently, their post-angiography inpatient stay was significantly reduced (0 [IQR 0–0] vs 1 [IQR 0–3] days; p<0.001; mean reduction 1.33 days, 95% CI 0.72–1.95). Angiography revealed a greater burden of coronary disease in the CPVW group compared to the retrospective cohort, with fewer unobstructed arteries (33% vs 94%; p<0.001) and higher rates of multi-vessel disease requiring intervention (27% vs 4%; p=0.02). No CPVW patients experienced 30-day readmission or mortality, compared with a 9% readmission rate in the retrospective cohort (p>0.05). The mean LOS reduction of 2.00 days for the 30 CPVW patients equates to 60 acute bed days saved, translating to a potential cost saving of £19,200 (assuming £320/bed day). Conclusion Management of low-risk ACS patients via CPVW is effective and associated with a significant reduction in acute-bed days and healthcare costs, without adverse outcomes. Interestingly, while risk-stratification tools effectively ensured safety across both cohorts, our prospective CPVW group had a higher burden of angiographic disease, emphasising the need for timely elective intervention.